The summary below is created by Glenn, your Benefits Administrator. For PDF document of summaries created by the insurance companies, click HERE.
Really into reading insurance benefits, and wish you could have more than the summaries? Click HERE for the full member handbook.
Glenn’s Summary of Benefits
Our insurance carrier (company) for the medical and pharmacy benefits is Regence Blue Cross Blue Shield of Oregon. Because Regence is part of the Blue Cross Blue Shield network, you have access to one of the nation’s largest provider networks around the US! i.e., if an out-of-state provider accepts Blue Cross Blue Shield coverage, they accept your GTFF insurance!
You have a $100 deductible for medical services. This means you are responsible for paying the first $100 of medical charges you receive each year. Once you’ve met the deductible your medical services will be covered at 90% if you visit one of the hundreds of preferred providers from Regence, and 70% if you choose a non-preferred provider.
All medical services, excluding massage, PT, and acupuncture, are all free if rendered at the UO Health Center clinic. This includes lab and x-ray’s.
Our plan has a $2,200 out of pocket maximum for in-network services. i.e., get hit by a blimp and have $6M in bionic surgery, the most you will pay is $2,200, not 10% of $6M.
GE’s have two dental plans offered by our insurance carrier, PacificSource Health Plans.
One is an “EPO” style and the other is a “PPO” plan. Both plans share the same network of dentists throughout Oregon.
The EPO provides the most comprehensive coverage in terms of amount and services covered, e.g., it has orthodontia, but does limit service to in-network dentists in Oregon. Every time you go in you will pay a flat copay fee. Cleanings will be $25. There is no cap on coverage per year.
The PPO does allow a GE and dependents to see any dentist in the U.S., (but you will maximize payouts going in-network in Oregon) but has a $1,500 annual cap on coverage. You’ll pay 20% of minor things like fillings, teeth extractions, root canals and 40% of major things like a crown. Cleanings are free if you go to in-network dentist.
You can switch plans in the fall term under our dental “open enrollment” period.
Prescriptions are covered at 70%. At major chain pharmacies all you need to do is show your insurance card and pay your 30% co-pay. The pharmacy will take care of billing Regence for the remaining charges. The 30% you end up paying counts towards your annual $2,200 out-of-pocket maximum. i.e., if you pay $2,200 in medical/prescription costs in one year, insurance will then pick up 100% of the medical/prescription bill after that.
In terms of confusing folks, this is confusing benefit #1! But rest easy, it’s actually simple:
Regence contracts your vision benefits to another carrier called Vision Service Plan (VSP). If an office looks you up under your Regence ID#, they will show you do not have vision benefits: do not worry! Have them look you up in VSP!
VSP does NOT use your Regence ID#, they use the last four digits of your SSN and DOB to look you up. You will NOT get a VSP card. In fact, if you look on back of your Regence card and you’ll see 800 number for offices to call VSP.
You will pay $10 for an exam and most lens will be free. Frames: you’ll pay $25 and insurance will pay up to $200. The lens are free, if you do not get any not medically necessary “add ons” (e.g., tint, anti-scratch, lightweight polycarbonate plastic) If you opt for contacts instead, insurance will pay up to $200 for them. You either get glasses *or* contacts, not both. Make sure you go to a preferred provider.
Physical, Occupational, and Speech Therapy, Massage, Chiropractic and Acupuncture
Massage, PT, Occupational, and Speech therapy fall under “rehabilitative” services. You have a 60 visit maximum limit for all rehabilitative services. 36 massages and 30 PT visits are covered by the insurance. Rehabilitative services do NOT require a “prior authorization,” simply make appointment with Regence in-network provider. No referral or deductibles needed.
You’ll also have 20 chiropractic and 20 acupuncture visits. All of these are covered like a standard medical office visit where you pay 10% at Regence providers.
For enrollment and benefits questions call Glenn Morris at 541-344-0832 or email firstname.lastname@example.org